Orthopedics 2

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HuskerDevil
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94430
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Orthopedics 2
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2011-07-18 15:17:31
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DPAP2012 Orthopedics
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Orthopedics flashcards made by previous students
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  1. Stretched or torn ligaments
    Sprains
  2. Muscle or tendon injury
    Strains
  3. bruise or hematoma
    Contusions
  4. Inflammation in tendon or tendon sheath caused by repeated stress
    Tendonitis
  5. Mechanism of action: Decrease sensitization of peripheral nerves and central sensory neurons
    NSAIDs
  6. MAO: Antipyretic and anti-inflammatory activity
    NSAIDs
  7. MAO: Prevent prostaglandin synthesis
    NSAIDs
  8. Adjuvant for bone pain; Analgesic ceiling; No tolerance or physiologic dependence
    NSAIDs
  9. Less GI toxicity; More liver toxicity; Renal toxicity possible
    Acetaminophen
  10. Less anti-inflammatory activity than other NSAIDs
    Acetaminophen
  11. first line therapy for osteoarthritis
    Acetaminophen
  12. Irreversible platelet effects
    Aspirin
  13. GI Toxicity; Hematologic Effects; Hypersensitivity; Hepatotoxicity
    NSAID AE
  14. Renal effects: Decreased renal prostaglandin (PG) synthesis
    NSAIDs
  15. GI protective effects compromised by addition of aspirin
    COX-2 Inhibitor: Celecoxib (Celebrex)
  16. Minimal effects on platelet aggregation No renal protective effects
    COX-2 Inhibitor: Celecoxib (Celebrex)
  17. Sulfa allergy warning
    COX-2 Inhibitor: Celecoxib (Celebrex)
  18. Cardiovascular risk
    NSAIDs and Celecoxib
  19. Increased risk of CV thrombotic events (MI, stroke)
    NSAIDs and Celecoxib
  20. Respiratory depression; CNS effects; Nausea and vomiting; Constipation
    Opioids: Side Effects
  21. Used for spasticity related to neuromuscular conditions (CP, MS, SCI)
    Antispastic
  22. Used for musculoskeletal spasms related to injury (short term use)
    Antispasmodic
  23. Baclofen (Lioresal®) Dantrolene (Dantrium®)Tizanidine (Zanaflex®)
    Antispastic
  24. Cyclobenzaprine (Flexeril®) Methocarbamol (Robaxin®) Tizanidine (Zanaflex®)
    Antispasmodic
  25. Most common adverse effects drowsiness and dizziness
    Skeletal Muscle Relaxants
  26. Fatal hepatocellular injury reported with long-term (1 month or more) use
    Chlorzoxazone
  27. Tricyclic antidepressant structure; shares adverse effects including anticholinergic activity and possible adverse cardiac effects
    Cyclobenzaprine
  28. In addition to drowsiness and dizziness, dry mouth a common side effect
    Cyclobenzaprine
  29. Hypersensitivity characterized by rash & pruritus
    Metaxalone
  30. AST, ALT, alkaline phosphatase and bilirubin elevations
    Metaxalone
  31. Most common adverse effects hypotension, sedation, dry mouth, constipation
    Tizanidine
  32. Sprains
    happen to ligaments
  33. Strains
    happen to muscles/tendons
  34. C5
    Biceps
  35. C6
    Brachioradialis
  36. C7
    Triceps
  37. Impingement Syndrome
    involves the Supraspinatus tendon
  38. Impingement Syndrome
    Hawkins and Neer tests
  39. Injuries to the AC joint are
    Separations (cross arm test – very good indicator)
  40. injuries to GH joint are
    dislocations ( apprehension, sulcus)
  41. Bankart (labrum) and Hill Sachs (humeral head)
    lesions can occur during a first time shoulder dislocation and subsequent reduction
  42. Most common fracture in the shoulder is
    fractured clavicle; commonly fractured between distal 1/3 and proximal 2/3
  43. Medial epicondylitis
    wrist flexors – Golfer’s Elbow
  44. Lateral epicondylitis
    wrist extensors – Tennis Elbow
  45. DeQuervains diagnosed by
    Finkelstein Test
  46. Finkelstein Test
    wrap thumb in palm and ulnar deviate) – tenosynovitis (inflammation of tendon sheath
  47. Scapholunate dissociation
    x-ray reveals Letterman sign (gap)
  48. Carpal Tunnel Syndrome
    Phalen and Tinel’s tests – MEDIAN N.
  49. Colles’ (FOOSH)
    dorsal displacement
  50. Smith (fall on flexed wrist)
    volar displacement
  51. Mallet finger
    DIP
  52. Boutonniere deformity
    PIP
  53. Heberden’s nodes
    DIP; Osteoarthritis,(most common)
  54. Bouchard’s nodes
    Osteoarthritis – PIP
  55. Spondylolysis
    Scotty Dog Fx – NON DISPLACED) – fx at pars interarticularis
  56. Spondylolisthesis
    Forward slippage of one vertebrae over another
  57. HNP (herniated discs)
    commonly cause muscle weakness w/ or w/o pain
  58. Hip avulsion fx sites: ASIS
    Sartorius
  59. Hip avulsion fx sites: AIIS
    rectus femoris
  60. Hip avulsion fx sites: Ischial tuberosity
    Hamstrings
  61. Legg Calve Perthes
    AVN
  62. ACL
    Lachman, Ant. Drawer,
  63. PCL
    Sag, posterior drawer,
  64. MCL
    Valgus stress
  65. LCL –
    Varus stress
  66. Meniscus
    McMurray
  67. Osgood Schlatter Disease
    Tibial Tuberosity (Quadriceps insertion)
  68. Sever’s Disease
    calcaneus (Achilles tendon insertion)
  69. ATFL
    Drawer
  70. Talar Tilt
    CFL
  71. Valgus (eversion)
    Deltoid
  72. 5th Metatarsal Head fractures
    Avulsion (**most common), Jones (most problematic), Metaphyseal Stress fx
  73. Ottawa Imaging rules
    x-ray when bony tenderness and inability to bear weight
  74. Gout
    Uric acid crystals – 1st MTP joint (big toe) – very painful
  75. Degenerative Joint Disease, “wear and tear”
    Osteoarthritis
  76. Common joints: Hands, Knees, Hips, Spine
    Osteoarthritis
  77. Joint space narrowing; Sclerosis; Osteophytosis
    Osteoarthritis
  78. Base of thumb: 1st Carpometacarpal joint (CMC)
    Hand Osteoarthritis
  79. Distal interphalangeal joints (DIP)Proximal interphalangeal joints (PIP)
    Hand Osteoarthritis
  80. Medial compartment most commonly affected
    Knee Osteoarthritis
  81. Superior joint narrowing
    Hip Osteoarthritis
  82. Autoimmune arthritis
    Rheumatoid Arthritis
  83. Commonly affected joints: Hands; Hips, Atlantoaxial joint (C1-C2), Shoulder
    Rheumatoid Arthritis
  84. Soft tissue swelling, Osteoporosis, Joint space narrowing, Marginal erosions, Bilateral symmetry
    Rheumatoid Arthritis
  85. Proximal Involvement: Carpal bones; MCP joints, Ulnar deviation at MCP
    Hand RA Findings
  86. Superior joint space loss
    OA at hip joint
  87. Axial (central) joint space loss
    RA at Hip Joint
  88. Crystal induced arthropathy, Hyperuricemia: monosodium urate crystals in joints
    Gout
  89. Commonly affected joints: Feet; Hands
    Gout
  90. Well-defined erosions; Overhanging edges, Soft-tissue nodules (tophi); Random distribution; No osteoporosis
    Gout
  91. Calcium pyrophosphate deposition disease (CPPD)
    Pseudogout
  92. Chondrocalcinosis (calcified cartilage) Associated osteoarthritis (atypical locations)
    Pseudogout
  93. HLA-B27 Spondyloarthropathy
    Ankylosing Spondylitis
  94. Spine (fracture risk)Sacroiliac joints
    Ankylosing Spondylitis: Commonly affected joints
  95. Spine: Marginal symmetric syndesmophytes, vertebral body squaring;
    Ankylosing Spondylitis:
  96. Spine: Nonmarginal asymmetric syndesmophyte
    Psoriatic Arthritis
  97. SI joints: unilateral or bilateral sacroiliitis
    Psoriatic Arthritis
  98. Hands/Feet: proliferative erosions (DIPs), soft-tissue swelling
    Psoriatic Arthritis
  99. HLA-B27 Spondyloarthropathy, associated with infection, occurs in men
    Reiter’s Syndrome
  100. Spine: Nonmarginal asymmetric syndesmophyte
    Reiter’s Syndrome
  101. SI joints: unilateral or bilateral sacroiliitis
    Reiter’s Syndrome
  102. Identical to psoriatic arthritis except affects feet more than hands
    Reiter’s Syndrome
  103. DIP erosions; “pencil-in-cup
    Hand Psoriasis Arthritis
  104. SI joints: Bilateral sacroiliitis;
    Ankylosing Spondylitis
  105. Pediatric fractures; Physis (growth plate) fractures
    Salter-Harris fractures
  106. C1 ring fracture; Blow to top of head; Lateral masses of C1 split apart; Ring fracture
    Jefferson Fracture
  107. Tip of dens; Usually stable
    Odontoid (dens) fracture: Type I
  108. Base of dens; Most common
    Odontoid (dens) fracture: Type II
  109. Through C2 body; Unstable
    Odontoid (dens) fracture: Type III
  110. Usually anterolisthesis of C2 on C3
    Hangman Fracture
  111. Fracture through posterior elements of C2
    Hangman Fracture
  112. Hyperextension and distraction; (head vs. dashboard);Unstable
    Hangman Fracture
  113. Severe hyperflexion; Anterior vertebral body wedging; Disruption of posterior ligaments; Anterior avulsion fracture
    Tear drop avulsion fracture
  114. Pars interarticularis defect “Scotty dog” fracture
    Spondylolysis
  115. Subluxation of adjacent vertebral bodies; Antero- and retrolisthesis, Laterolisthesis less common
    Spondylolisthesis
  116. Degenerative (osteoarthritis) change
    Spondylosis
  117. Commonly occur at proximal 2/3 and distal 1/3 clavicle
    Clavicle Fracture
  118. normal shoulder that the humeral head slightly overlaps the glenoid
    crescent sign.
  119. An anteroposterior view of the right shoulder shows the humeral head to lie medial to the glenoid and inferior to the coracoid process
    diagnostic of an anterior dislocation of the shoulder
  120. aiming the x-ray beam parallel to the shoulder blade
    transscapular view
  121. Joint space narrowing; Bony overgrowth at edge of joint (osteophyte); Sclerosis (density along articular surfaces
    Shoulder Osteoarthritis
  122. Common pediatric elbow fracture
    Supracondylar fracture
  123. Common adult elbow fracture
    Radial head fracture
  124. Margin of anterior vertebral bodies
    C-Spine Interpretation – Lateral: Line 1
  125. Margin of posterior vertebral bodies
    C-Spine Interpretation – Lateral: line 2
  126. Margin of the bases of the spinous processes
    C-Spine Interpretation – Lateral: line 3
  127. Posterior spinous line
    C-Spine Interpretation – Lateral: line 4
  128. C5-6 interspace
    C6 nerve root
  129. Cervical Sprain
    Whiplash
  130. Jefferson Fx
    C1 burst fx
  131. Hangman Fx
    C2 fx/dislocation
  132. Clay Shoveler’s Fx
    C7 spinous process fx
  133. C5-T1: Burner; Spurling's maneuver
    Brachial Plexus
  134. Cervical disc degeneration
    Spondylosis
  135. UE radicular sx in dermatome pattern
    HNP
  136. Supraspinatus
    Abduction
  137. Infraspinatus
    External rotation
  138. Teres Minor
    External rotation
  139. Subscapularis
    Internal rotation
  140. Apprehension sign / Sulcus sign
    Joint Stability
  141. Abduction; Resisted abduction; Hawkin’s sign; Neer’s sign
    Supraspinatus
  142. Scarf or Cross Over test
    AC joint
  143. Internal rotation; “Lift-Off” test
    Subscapularis:
  144. External rotation; Resisted External rotation
    Infraspinatus/Teres minor:
  145. Yergason’s test (resisted supination); Speed’s test (resisted forward flexion)
    Biceps tendon
  146. resisted supination
    Yergason’s test
  147. resisted forward flexion
    Speed’s test
  148. Avulsion of the antero-inferior glenoid labrum
    Bankart lesion
  149. Compression fx of posterior humeral head
    Hill-Sachs lesion:
  150. touch opposite ear over head
    Rowe maneuver
  151. prone, weights off table
    Stimson maneuver
  152. traction / counter traction
    Hippocratic
  153. Inspect for: Cortical defects; Radiocapitellar line; Anterior humeral line; Fat pad sign
    Elbow Radiographs
  154. Usually normal; Sail sign
    Anterior fat pad
  155. Always pathologic; Radial head fx in adults; Supracondylar fx in kids
    Posterior fat pad
  156. PE: Pain over lateral epicondyle with resisted wrist extension & supination
    Lateral Epicondylitis
  157. Hx: Elbow pain from repetitive wrist extension
    Lateral Epicondylitis
  158. Golfer’s elbow; Mechanism: Repeated flexion Dx: Resisted wrist flexion/ pronation
    Medial Epicondylitis:
  159. Hx: May be traumatic or insidious. D/D: Infection, Gout, triceps rupture. PE: Red, swollen joint, + pain
    Olecranon Bursitis
  160. PE: Red, swollen joint, + pain
    Olecranon Bursitis
  161. Percuss over the median nerve in the carpal tunnel.
    Tinel’s Sign:
  162. Acute flexion of wrists for 60-90 seconds
    Phalen’s Test:
  163. Compression of the median nerve
    Carpal Tunnel Syndrome
  164. Mechanism: Repetitive motion. Sx: Night pain, numbness in median nerve distribution. May advance to thenar wasting
    Carpal Tunnel Syndrome
  165. a beak, bulge or density at the fused epiphyseal line is not a fracture but a
    physeal scar
  166. Distal radial fx with volar angulation of the distal fragment
    Smith Fx
  167. Distal radial fx with dorsal angulation of the distal fragment
    Colles’ Fx
  168. Most common carpal fracture; 70-80% of carpal injuries; FOOSH injuries; Snuffbox pain
    Scaphoid Fractures
  169. 1/3 will develop osteonecrosis; May not be evident acutely, repeat films 10 days
    Scaphoid Fractures
  170. “Letterman Sign”
    Scapholunate Dissociation
  171. Ring and small palmar fascia contracture
    Dupuytren's Disease
  172. Stenosing tenosynovitis
    Trigger finger
  173. UCL injury
    Skier’s thumb
  174. Associated deformities
    OA / RA
  175. 5th MC neck
    Boxer’s
  176. DIP avulsion fracture
    Mallet Finger
  177. Osteoarthritis at PIP joint
    Bouchard’s nodes
  178. Osteoarthritis at DIP joint (more common)
    Heberden’s nodes:
  179. Hard & painless; Due to bony overgrowth; Thumb CMC joint pain site for early sx in women
    Osteoarthritis
  180. Ulnar deviation of fingers
    Rheumatoid Arthritis
  181. Swan neck deformity & Boutonniere deformity
    Rheumatoid Arthritis
  182. Chronic swelling, decreased ROM; Bony erosion; Rheumatoid nodules on lateral forearm
    Rheumatoid Arthritis
  183. Pain on hip flexion reproduces radicular pain
    SLR:
  184. Foot dorsiflexion increases pain
    Bragard’s test:
  185. Raising ipsilateral leg causes radicular pain on contralateral leg
    Cross SLR test:
  186. Pain in SI joint
    FABER:
  187. Pain & back extension when raising affected leg in seated position. One of the Waddell’s signs.
    Flip test:
  188. Reveals weakness of the hip abductors of the standing leg
    Trendelenburg:
  189. PE: Tender paravertebral or erector spinae muscles. Minimal radiation
    Lumbar Strain
  190. History, mechanism of injury, site of pain; 70% of LBP
    Lumbar Strain
  191. L4-5, L5-S1 most common
    Herniated Nucleus Pulposus
  192. SX: Sciatica; Signs: Positive SLR, Pain worse in certain positions
    Herniated Nucleus Pulposus
  193. Mechanism: Flexion & rotation; Tears in annulus
    Herniated Nucleus Pulposus
  194. Radiating pain, numb & weakness to lower extremity
    Sciatica
  195. for primary tumors, metastatic disease, or infection
    Tc 99m bone scan
  196. Collapse of anterior wall of vertebral body
    Wedge
  197. Lucency through the spinous process
    Spinous process
  198. Crack through the eyes, or an open beak
    Chance
  199. Increased distance between Pedicles, or a decrease in vertebral body height
    Burst
  200. Pars interarticularis fx; Dancers, gymnasts, lifters; Most occur L5
    Spondylolysis
  201. Pain adjacent to midline, á with extension & rotation; Scotty dog on oblique x-ray
    Spondylolysis
  202. Vertebral sliding, Dancers, gymnasts
    Spondylolisthesis
  203. PE: Step-off, may be asx.; Grade I – V (25- >100%); Isthmic, degenerative; Lateral film shows slip
    Spondylolisthesis
  204. Lateral curvature; Occurs in T or L spine; Idiopathic most common; Girls 7x > than males
    Scoliosis
  205. associated with organ & vascular laceration
    High energy pelvis fx
  206. Fx commonly disrupted in 2 places
    Pelvic ring fx
  207. 90% in those > 65 y/o
    Hip Fractures
  208. Sx: Pain, shorter, rotated leg. Risk: Age, sex, nutrition, meds
    Hip Fractures
  209. 90% are posterior; PE: Hip flexed, adducted & internally rotated; Lateral x-ray
    Hip Dislocation
  210. Origin of sartorius
    Avulsion Fractures of the Hip: ASIS
  211. Mechanism: knee flexed & hip hyper-extended
    Avulsion Fractures of the Hip: ASIS
  212. PE pain over ASIS, & with resisted hip flexion
    Avulsion Fractures of the Hip: ASIS
  213. Dx: x-ray may reveal avulsion fx. Rx: RICE, progressive weight bearing, splint with knee flexed, S&S, surgery for displace fx
    Avulsion Fractures of the Hip: ASIS
  214. Origin of hamstring
    Avulsion Fractures of the Hip: Ischial tuberosity
  215. Vigorous hip flexion/knee extension. Pain in buttock
    Avulsion Fractures of the Hip: Ischial tuberosity
  216. PE: pain at ischial tuberosity
    Avulsion Fractures of the Hip: Ischial tuberosity
  217. Thin, female endurance athletes. Amenorrhea, anorexia, osteoporosis
    Femoral Stress Fracture
  218. Groin pain with running, progressing to pain with ADL pain; NIGHT PAIN; PE: pain limits extremes of int. & ext. rotation
    Femoral Stress Fracture
  219. Lateral femoral cutaneous nerve entrapment. Exits pelvis near ASIS
    Meralgia Paresthetica
  220. Sx: Pain & burning over the lateral thigh. Etiology: Obesity, tight clothing, repetitive trauma (tight jeans)
    Meralgia Paresthetica
  221. Avascular necrosis of the femoral head. Child 2-11 y/o
    Legg-Calve-Perthes
  222. Insidious groin/thigh pain; Limp. PE: loss of int / ext rotation. X-ray: mottled femoral head
    Legg-Calve-Perthes
  223. Obese, adolescents; 40% are bilateral; Most are idiopathic; X-ray: Slipped ice cream cone
    SCFE
  224. Presents with limp and hip, thigh, or knee. PE: Loss of IR, flexion, & abduction
    SCFE
  225. Lachman 15-20º, Anterior Drawer (90 deg knee flex)
    ACL:
  226. Sag sign, Posterior Drawer
    PCL:
  227. Varus
    LCL
  228. Valgus stress
    MCL
  229. McMurray test, joint line pain
    Meniscus:
  230. Q-angle, Patella grind, anterior pain, tracking
    PFS:
  231. Radiographic changes
    Arthritis:
  232. Lateral femoral condyle
    ITB:
  233. Tibial Tubercle Apophysitis
    Osgood Schlatter Dz:
  234. Apprehension sign
    Patella Dislocation:
  235. Pain over tendon insertion
    Patella Tendonitis
  236. ACL / MCL / Medial meniscus
    Terrible Triad
  237. Medial tibial plateau
    Pes Anserine Bursae
  238. Axial blow to the head with force transmitted through the occipital condyles; Forces the lateral masses of C1 outward
    Jefferson's fracture
  239. bilateral C2 pedicle fractures (usually due to combo of forces; eg, hyperextension and sudden violent distraction)
    Hangman's fracture
  240. Thickened palmar fascia forms nodules over the flexor tendons causing a flexion contracture
    Dupuytren’s Contracture

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